Sleep disordered breathing, including snoring and obstructive sleep apnea, affects tens of millions of adults in the United States. It is associated with substantial cardiovascular morbidity and mortality, endocrine disturbances, excessive daytime sleepiness, quality of life and performance deficits, and motor vehicle crashes.
Treatment options include behavioral measures such as weight loss, positive airway pressure therapy, surgery, and oral appliances. All treatments have strengths and weaknesses, and in particular surgical treatment has outcomes that vary widely among patients and procedures.
The evaluation of patients with sleep disordered breathing may improve outcomes of surgical treatment. The goals of such evaluation include characterizing (1) the pattern of airway obstruction (involving primarily the palate/tonsils region, tongue base, epiglottis, and/or lateral pharyngeal walls) and (2) the site of sound production. Existing upper airway examination techniques, however, may not provide an accurate evaluation of the pharynx during natural sleep as explained below.
A flexible endoscope such as the Olympus fiberscope or the Olympus video scope may be utilized to examine a patient's upper airway during wakefulness, natural sleep or sedation. Examination during natural sleep may provide the best results, but attempts to perform traditional natural sleep endoscopy have been largely abandoned for multiple reasons, including the fact that it requires that an operator be present to hold the endoscope in place during the often prolonged period needed for patients to fall asleep with the endoscope in place. The behavior of the upper airway during wakefulness differs dramatically compared to natural sleep, which makes examinations during wakefulness insufficient. Sedation is costly because it requires a controlled environment and the involvement of highly trained personnel and specialized equipment. In addition, sedation may alter the pattern of upper airway obstruction.
Current examinations during wakefulness, sedation, and natural sleep are also limited because their duration is typically no more than 10-15 minutes due to personnel and financial constraints. It is unclear whether this abbreviated examination adequately describes pharyngeal behavior through an entire night of sleep.
There is enthusiasm among clinicians and patients alike for improved surgical evaluation techniques, particularly techniques that provide an accurate, dynamic assessment of the upper airway during natural sleep without the need for sedation, the presence of a clinician, or the associated costs.